Zolper Elizabeth G, Harbour Patrick W, Dekker Paige K, Schwitzer Jonathan A, Viramontes Ariel, Evans Karen K
Georgetown University School of Medicine; Washington, D.C.
Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, D.C.
Plast Reconstr Surg Glob Open. 2021 Feb 16;9(2):e3427. doi: 10.1097/GOX.0000000000003427. eCollection 2021 Feb.
A 28-year-old woman with poor wound healing and surgical site pain presented 5 days post-cesarean section (post-CS) with vasopressor-dependent shock and was eventually diagnosed with postoperative pyoderma gangrenosum (PG). A worsening clinical picture consistent with presumed necrotizing infection necessitated surgical debridement. The patient was ultimately taken to the operating room 4 times with transient improvement after the operations when she received perioperative corticosteroids. We were unable to identify an infectious source and cultures revealed no microorganisms. Dermatopathology revealed neutrophilic infiltrate and focal necrosis without microorganisms. The biopsy site began to concurrently exhibit pathergic changes, leading to a diagnosis of PG. Twelve weeks later, she underwent DPC of her abdominal wound while maintained on an immunosuppressive regimen of cyclosporine and prednisone. Incisional negative pressure wound therapy with a small window was used in the immediate postoperative period to allow for direct visualization of the closed incision. She healed without issue and her immunosuppressive regimen was ultimately discontinued. Postoperative PG is an uncommon diagnosis with high risk of morbidity. It is often mistaken for necrotizing infection. We report a unique case of post-CS PG presenting as vasopressor-dependent shock that was successfully closed with incisional negative pressure wound therapy with a small window.
一名28岁女性在剖宫产术后5天出现伤口愈合不良及手术部位疼痛，伴有依赖血管升压药的休克，最终被诊断为术后坏疽性脓皮病（PG）。临床症状恶化，疑似坏死性感染，需要进行手术清创。该患者最终4次被送进手术室，在接受围手术期皮质类固醇治疗后，术后有短暂改善。我们未能确定感染源，培养结果未发现微生物。皮肤病理学显示有中性粒细胞浸润和局灶性坏死，但无微生物。活检部位同时开始出现同形反应性改变，从而诊断为PG。12周后，她在接受环孢素和泼尼松免疫抑制治疗的同时，对腹部伤口进行了二期愈合。术后立即采用小窗口切开负压伤口治疗，以便直接观察闭合的切口。她顺利愈合，最终停用了免疫抑制治疗方案。术后PG是一种罕见的诊断，发病风险高。它常被误诊为坏死性感染。我们报告了一例独特的剖宫产术后PG病例，表现为依赖血管升压药的休克，通过小窗口切开负压伤口治疗成功愈合。
